No abstract available.
Vesico-Ureteral Reflux*

PURPOSE: The purpose of this study was to analyze the clinical effectiveness of open reduction in the treatment of distal humeral fracture using a newly designed combined approach of anterolateral and lateral approaches to protect the radial nerve. MATERIALS AND METHODS: We investigated 24 consecutive cases of distal humeral fracture who received open reduction and internal fixation with a plate and screws with a minimum follow-up period of 1 year. We analyzed the patients' age, sex, fracture pattern, timing of the union, range of motion of the elbow joint, and complications. The Mayo elbow performance index (MEPI) was employed for the assessment of elbow joint function. RESULTS: Clinical union was observed at 10.8 weeks (6~20 weeks) on average. Pre-operatively, there were 3 cases of incomplete radial nerve palsy. All of the cases recovered, and there was no additional radial nerve palsy due to surgery. According to the MEPI, 13 cases were "excellent" and 10 cases were "good" or better, comprising 95.83% of the cases. The range of motion at the elbow was 5.5 degrees (0~15 degrees) of extension, and 131.5 degrees (120~145 degrees) of flexion, suggesting no functional disability. The duration of return to work was 11.2 weeks (5~32 weeks) on average. There were no nonunion, malunion, or infection complications. CONCLUSION: The combined anterolateral and lateral approach we designed is a clinically effective approach due to facilitation of protection of the radial nerve and attainment of adequate fixation space.
Elbow ; Elbow Joint ; Follow-Up Studies ; Humeral Fractures ; Humerus ; Paralysis ; Radial Nerve ; Range of Motion, Articular ; Return to Work

A case of infectious mononucleosis was presented. She was admitted to the hospital with the anterior cervical lymphadenopathy. Erythematous skin rashes on both low extermities, and splenomegaly. Her chief complaints were fever and sore throat. She showed atypical lymphocytes in peripheral blood smear with relative lymphocytosis. Mono-spot test was positive. She received symptomatic therapy and discharged without any complications. So, we report this case and review the brief literatures of infectious mononucleosis with the respect to etiology, clinical course, and histological characteristics of the disease.
Exanthema ; Fever ; Infectious Mononucleosis ; Lymphatic Diseases ; Lymphocytes ; Lymphocytosis ; Pharyngitis ; Splenomegaly

Mechanical complications of acute myocardial infarction which may lead to heart failure or shock include ruptute of left ventricular free wall, ventricular septum and papillary muscle. The clinical characteristics of these lesions vary conservative management alone has high mortality rate, for which reason surgical repair of these defects are essential. Structural defects including rupture of the left ventricular free wall, ventricular septum, and papillary muscle, accout for 5% to 20% of all deaths from acute myocardial infarction. Among these, ventricular septal defects occur in approximately 1% of all myocardial infarction, and account for up to 2% of deaths subsequent to myocardial infarction. Rupture of the ventricular septum following acute myocardial infarction(AMI) is associated with high mortality rate, as 54% of the patients succumb within two weeks, 87% within two months and 92.5% during the first year. We experienced two cases of postinfarct ventricular septal defects(VSD) which had been repaired within 1 week after AMI due to progressive deterioration of patients` conditions, and were to be reoperated because of repeated septal ruptures in postoperation period and development of cardiogenic shock.
Heart Failure ; Heart Septal Defects, Ventricular ; Humans ; Infarction* ; Mortality ; Myocardial Infarction ; Papillary Muscles ; Rupture ; Shock ; Shock, Cardiogenic ; Ventricular Septum

PURPOSE: This study was performed in order to compare unenhanced CT with diffusion-weighted, T2-weight-ed,and fast FLAIR MR imaging in the detection of hyperacute cerebral ischema induced in a dog and to deter-mine whichmodality first detected cerebral ischemia. MATERIALS AND METHODS: Experimental cerebral infarction was induced bythe occlusion of intracerebral arter-ies using embolic materials (polyvinyl-alcohol, 300 -6 00 micro) introducedthrough a microcatheter into the internal carotid artery of five dogs weighing 12 -20 kg. Serial CT and MR imageswere obtained at one hour intervals from one to five hours after occlusion, and were analyzed independently by tworadiologists. We assessed changes in attenuation, as seen on unenhanced CT and the signal intensity of the lesionon each MR image, and measured the contrast-to-noise ratio (CNR) of the lesions. RESULTS: Ischemic lesions weredetected on unenhanced CT 1 -3 hours after occlusion of cerebral arteries. In all dogs, the lesions were detectedearliest on diffusion-weighted images obtained at 1 hour. They were detect-ed on T2-weighted images at 3 -5 hoursand on fast FLAIR images of 2 -5 hours. The CNR of ischemic lesions increased gradually during the 5-hour period.It was highest on diffusion-weighted images, while on unen-hanced CT, T2-weighted, and fast FLAIR images it wassimilar. CONCLUSION: Hyperacute ischemic lesions were detected earliest on diffusion-weighted images, and earlieron unenhanced CT than on fast FLAIR or T2-weighted MR image.
Animals ; Brain Ischemia ; Carotid Artery, Internal ; Cerebral Arteries ; Cerebral Infarction* ; Dogs* ; Magnetic Resonance Imaging*

Toxic epidermal necrolysis (T~EN) is a severe mucocutaneous disease characterized by epidermal necrosis possibly extended to the entire body surface and involving multiple internal organs. Digestive tract may be involved too, but there is few report about gastrointestinal lesion in patient with TEN. Recently we experienced a case of TEN with gastrointestinal bleeding in previously healthy 32-year-old woman. The condition developed three days after the initiation of treatment with NSAID and progressed caudally, involving 60 percent of the skin surfaces. During a period of admission gastrointestinal bleeding was noticed. The gastrofiberscopy showed diffuse superficial mucosal lesion with oozing from swollen friable and erythematous mucosa. The skin lesion was progressed inspite of withdrawal of causative agents. The patient was expired due to combined septic shock 10 days later. We report this case with gastrofiberscopic findings and a brief review of literature.
Adult ; Female ; Gastrointestinal Tract ; Hemorrhage* ; Humans ; Mucous Membrane ; Necrosis ; Shock, Septic ; Skin ; Stevens-Johnson Syndrome*

Multidirectional coronary artery fistulas (CAFs) are rare in patients with tetralogy of Fallot (TOF). We report an adult patient who underwent open-heart surgery for TOF 24 years before the discussed presentation. Coronary angiogram and cardiac computed tomography revealed multidirectional CAFs originating from the left main coronary artery and draining to the left atrium, pulmonary artery and subphrenic artery. The patient also showed additional congenital anomalies, such as persistent left superior vena cava and right-sided aortic arch.
Adult* ; Aorta, Thoracic ; Arteries ; Arteriovenous Fistula ; Coronary Vessels* ; Fistula* ; Heart Atria ; Humans ; Pulmonary Artery ; Tetralogy of Fallot* ; Vena Cava, Superior

PURPOSE: To study the effect of recombinant human epidermal growth factor (rhEGF) on oral mucositis induced by cisplatin and radiotherapy in a mouse model. MATERIALS AND METHODS: Twenty-four ICR mice were divided into three groups? the normal control group, the no rhEGF group (treatment with cisplatin and radiation) and the rhEGF group (treatment with cisplatin, radiation and rhEGF). A model of mucositis induced by cisplatin and radiotherapy was established by injecting mice with cisplatin (10 mg/kg) on day 1 and with radiation exposure (5 Gy/day) to the head and neck on days 1~5. rhEGF was administered subcutaneously on days -1 to 0 (1 mg/kg/day) and on days 3 to 5 (1 mg/kg/day). Evaluation included body weight, oral intake, and histology. RESULTS: For the comparison of the change of body weight between the rhEGF group and the no rhEGF group, a statistically significant difference was observed in the rhEGF group for the 5 days after day 3 of the experiment. The rhEGF group and no rhEGF group had reduced food intake until day 5 of the experiment, and then the mice demonstrated increased food intake after day 13 of the of experiment. When the histological examination was conducted on day 7 after treatment with cisplatin and radiation, the rhEGF group showed a focal cellular reaction in the epidermal layer of the mucosa, while the no rhEGF group did not show inflammation of the oral mucosa. CONCLUSION: These findings suggest that rhEGF has a potential to reduce the oral mucositis burden in mice after treatment with cisplatin and radiation. The optimal dose, number and timing of the administration of rhEGF require further investigation.
Animals ; Body Weight ; Cisplatin* ; Eating ; Epidermal Growth Factor* ; Head ; Humans* ; Inflammation ; Mice* ; Mice, Inbred ICR ; Mouth Mucosa ; Mucositis ; Mucous Membrane ; Neck ; Radiotherapy* ; Stomatitis*

The efficacy of 99mTc-ECD SPECT, [18F]FDG PET, and MRI for the localization of seizure foci was evaluated in 110 patients with partial epilepsy [77 with temporal lobe epilepsy (TLE); 33 with extratemporal lobe epilepsy (ETLE)]. Two standards were employed for the determination of seizure foci: 1) clinico-electrical data and 2) postoperative outcome. In 77 patients with TLE, the sensitivities of interictal and ictal SPECT, [18F]FDG PET, and MRI for the localization of seizure foci were 63%, 90%, 87%, and 80%, respectively. PET localized seizure foci correctly in 75% of TLE patients with normal or nonlocalizing MRI while seizure foci were localized correctly by MRI in 60% of TLE patients with nonlocalizing PET. In 33 TLE patients with good surgical outcome (Engel classes I, II) and greater than one year follow-up, the sensitivities of interictal and ictal SPECT, PET, and MRI were 46%, 100%, 88%, and 82%, respectively. The frequency of extratemporal hypometabolism on preoperative PET was significantly higher in TLE patients with Engel classes IB-IV than in TLE patients with Engel class IA(5/19 vs 14/17, p<0.001). In 33 patients with ETLE, the sensitivities of the neuroimaging studies for the localization of seizure foci were lower: ictal SPECT, 57%; interictal SPECT, 35%; PET, 36%; and MRI, 21%. In 9 ETLE patients with good surgical outcome and greater than one year follow-up, the sensitivities of interictal and ictal SPECT, PET, and MRI were 43%, 50%, 22%, and 33%, respectively. The data demonstrate that ictal perfusion SPECT and [18F]FDG PET may be useful for the localization of seizure foci in TLE. Additionally, the presence of extratemporal hypometabolism in TLE might indicate an unfavorable surgical outcome.
Epilepsies, Partial* ; Epilepsy ; Epilepsy, Temporal Lobe ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Neuroimaging ; Perfusion ; Positron-Emission Tomography ; Seizures* ; Tomography, Emission-Computed, Single-Photon*

Gastroesophageal reflux disease (GERD) is thought to be caused by an incompetent lower esophageal sphincter, either because of a chronic hypotonia or an increased frequency of transient lower esophageal sphincter relaxation. Thus, it seems paradoxical under nutcracker esophagus to consider gastroesophageal reflux as a possible diagnosis, particularly in the patient presenting with chest pain. Current therapy in nutcracker esophagus is aimed at reducing the high amplitude peristaltic contractions characteristic of this disorder. Treatment directed at reducing contraction can decrease lower esophageal sphincter pressure and may exacerbate gastroesophageal reflux. It is not easy to treat a case of nutcracker esophagus associated with GERD. We report a 38-year-old male with nutcracker esophagus associated with GERD who lost the diagnostic features of nutcracker esophagus after 6 week of antireflux therapy.
Adult ; Chest Pain ; Diagnosis ; Esophageal Motility Disorders* ; Esophageal Sphincter, Lower ; Gastroesophageal Reflux* ; Humans ; Male ; Manometry* ; Muscle Hypotonia ; Omeprazole* ; Relaxation